Nausea and Vomiting Risk
Nausea, vomiting, and diarrhoea are the most frequently reported adverse events with tirzepatide across all SURPASS trials. The rates are consistent with the GLP-1 receptor agonist class effect (gastric emptying slowing, central GLP-1 receptor activation). In SURPASS-1, nausea affected 12–18% of tirzepatide patients vs 6% on placebo; in SURPASS-2 vs semaglutide, rates were broadly similar (17–22% vs 18%); in SURPASS-4 vs insulin glargine, the contrast was large (12–23% vs 2%).
Ontology Nausea and Vomiting Risk [warns_about] Tirzepatide Nausea and Vomiting Risk [relates] GLP-1 Receptor Agonism Nausea and Vomiting Risk [reported_in] SURPASS-1 Nausea and Vomiting Risk [reported_in] SURPASS-2
Numbers
| Trial | Nausea (tirzepatide) | Comparator | Vomiting (tirzepatide) | Comparator |
|---|---|---|---|---|
| SURPASS-1 (5/10/15mg vs placebo) | 12%/16%/18% | 6% | 2%/6%/6% | 2% |
| SURPASS-2 (5/10/15mg vs semaglutide 1mg) | 17%/18%/22% | 18% | 6%/8%/10% | 8% |
| SURPASS-4 (5/10/15mg vs glargine) | 12%/18%/23% | 2% | 5%/8%/9% | 2% |
| SURPASS-6 (pooled vs lispro) | 14%–26% | not reported | 5%–13% | not reported |
Discontinuation due to nausea, vomiting, or diarrhoea: ≤3% per event across SURPASS-1 to -5.
Practical Interpretation
- Who appears most at risk: All patients; higher with 15mg dose; peak during dose escalation in first 4–12 weeks
- Severity: Mostly mild to moderate; transient — resolves or improves after reaching maintenance dose
- Mitigation: 4-week dose escalation schedule (starting at 2.5mg) designed to reduce GI events; food intake reduction may also help
- Evidence: Consistent across all 6 SURPASS trials; well-characterised class effect
Connections
- Tirzepatide — warns_about, [2022], source: FDA label
- GLP-1 Receptor Agonism — may_explain
- SURPASS-1 — reported_in, [2021]
- SURPASS-2 — reported_in, [2021]